Compliance Inspection Compliance Inspection Compliance Inspection # CI-2023-3739, Submission # Submission-2023-3967, UID # 49834
Status: Compliance Inspection Accepted
 

System Status

System status on date: 11/06/2023 System Status: Compliant

Property Information

Property Information:
Compliance StatusProperty RecordProperty AddressProperty OwnerProperty Attributes
Compliance ExpirationCompliance StatusParent GeoCodePINSite AddressBuilding NumberStreet NameTypeDirCityMunicipalityzipOwnerLotBlockPlat Year BuiltProperty Hold
14028202100902045 QUEBEC AVE S, CITY OF LAKE ST CROIX BEACH2045QUEBECAVESLAKELANDCITY OF LAKE ST CROIX BEACH55043RAVEN CHARLES A & LEONA A1961
Owner's representative:
Name:
Charles Raven
Phone:
(651231 - 6599
Email:
sssepticsolutions@gmail.com

Impact on Public Health

System discharges sewage to
the ground surface:
No System discharges sewage to
drain tile or surface waters:
No System causes sewage backup
into dwelling or establishment:
No
Verification method(s):
Searched for surface outlet
Searched for seeping in yard/backup into home

Tank Integrity

System consists of seepage pit,
cesspool, drywell, or leaching pit:
No
Sewage tank(s) leak below their
designed operating depth:
No
Verification method(s):
Examined empty (pumped) tank(s)

Other Compliance Conditions

Maintenance hole covers are damaged, cracked,
unsecured, or appear to be structurally unsound:
No
Other issues (electrical hazards, etc.) to
immediately and adversely impact public
health or safety:
No
System is non protective of groundwater for other
conditions as determined by the inspector:
No

Date of Install

Date of install known: Yes
Date of installation: 11/10/1993

Soil Separation

Shoreland/Wellhead Protection/Food, beverage, lodging? No
Drainfield has at least a two-foot vertical separation
distance from periodically saturated soil or bedrock:
Yes
Drainfield meets the designed vertical separation
distance from periodically saturated soil or bedrock.:
Yes
Verification method(s):
Conducted soil observation(s) (Attach boring logs)
A. Bottom of distribution media: 3.5 Decimal Feet
B. Periodically saturated soil/bedrock: 5.5 Decimal Feet
C. System separation: 2 Decimal Feet
D. Required compliance separation: 2 Decimal Feet

Operating Permit and Nitrogen BMP

Is system operating under an Operating Permit: No
Is the system required to employ Nitrogen BMP: No

Comments and File Attachments

Attach Files:

Certification

Inspector:
NameLicense NumberPhone NumberAddressMaintainerInstallerService ProviderDesignerInspector
SS Septic Solutions LLCL4137651-343-911714845 113th St S Hastings, MN 55033NoYesNoYesYes
Please search for and choose SELF/OTHER if what you need does not appear in the list
Inspector Email Address: sssepticsolutions@gmail.com

Terms

Certification
  • By submitting this form I hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determination of the future
    system performance has been nor can be made due to unknown conditions during system construction, possible abuse of the system, inadequate
    maintenance, or future water usage

Invoice #9730 (11/06/2023)

Charge Cost Quantity Total
Non-Taxable
added 11/06/2023 6:41 PM

$47 Flat Fee

$45.00 x 1 $45.00
Grand Total
Total $45.00
Payment 11/06/2023$45.00
Due$0.00
Action: Print  

Approvals

ApprovalSignatureOptions
ApplicantShelley L. Schlomka - 11/06/2023 6:41 PM
b763bd1a0d6cbf1bc70f1c11ef04ccdf
4f6577955e182b210629ab55da197967
 
#1 Compliance Inspection AcceptedSarah Borrell - 12/21/2023 3:43 PM
32d74375554db55306c4baafac8dcf2c
87e6e18f8348b3865a224f06e547ea4b
 
Inspection has been approved. All signatures have been obtained.
Text:
File(s):
    Text:
    Attached communication requesting to change report due to number listed in report. Old report listed for reference and no changes to inspection other than noting 4 lines in existing STA vs 3.
    File(s):
    Compliance Letter Type: Certificate of Compliance Who's signature should be on the letter? Sarah Borrell Permit number to reference in "No Replace" letter:
    Was the letter sent? Yes Compliant/Non-Compliant: Compliant
    Certificate of Compliance:
      Letter of Non-Compliance:
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